Provider Demographics
NPI:1134499916
Name:A CENTER FOR NECK & BACK PAIN RELIEF LLC
Entity type:Organization
Organization Name:A CENTER FOR NECK & BACK PAIN RELIEF LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DREW
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:COLAGROSSO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-433-7117
Mailing Address - Street 1:3890 FEDERAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-2054
Mailing Address - Country:US
Mailing Address - Phone:303-433-7117
Mailing Address - Fax:303-433-3177
Practice Address - Street 1:3890 FEDERAL BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-2054
Practice Address - Country:US
Practice Address - Phone:303-433-7117
Practice Address - Fax:303-433-3177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3079111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty